SIU Medical & Behavioral Health Coder (CPC)

4004 Aetna Medicaid Administrators; Connecticut; Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The candidate will ensure coding accuracy, review medical records, and provide detailed findings to investigators and leadership. Strong knowledge of CPT/HCPCS and Revenue Codes is required, with 3+ years of coding experience.

The role offers full-time employment with a 40-hour work week, benefits, and potential bonuses. Travel may be required.

Qualifications

• AAPC CPC certification.
• Minimum 3 years medical/behavioral health coding with 1–2 years of current review experience.
• Knowledge of CPT, HCPCS and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to apply coding policies consistently.
• Experience with Excel and Word.
• Ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify codes match documentation.
• Provide detailed written summaries of findings.
• Articulate findings to investigators and leadership.
• Research CMS/state guidelines related to reviews.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative coding research.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities for prepayment reviews.
• Maintain records and documentation.
• Keep up-to-date coding knowledge.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

MS Excel/Word

Travel flexibility

Education

AAPC CPC Certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The candidate will ensure coding accuracy, review medical records, and provide detailed findings to investigators and leadership. Strong knowledge of CPT/HCPCS and Revenue Codes is required, with 3+ years of coding experience.

The role offers full-time employment with a 40-hour work week, benefits, and potential bonuses. Travel may be required.